MOMS FAQs

Following are the questions that people ask most often. Please contact us with other questions you may have or for clarification.

Why don't you take
supplies for the clinics?

A: We make sure that everything
we do is sustainable and leads to independence for the women we teach and their villages. If we
take supplies, then what happens when they're gone? The clinic staff comes to
rely on those items for providing care, and on us to provide the items.

We prefer to discuss how to find other ways to get what they need. Gloves
are a good example.

Remember that MOMS provides a
grant for the women to start a self-sustaining project. So, they can buy gloves for the clinic. We have taught them to scrub their
hands and fore-arms thoroughly, so they find ways do
that - commission a local carpenter to build a stand to hold a pitcher, bowl,
soap, brushes, and towels.

We are not
trying to replicate an American clinic in the middle of the Sierra Leonean
rain-forest. We are helping them to develop their villages so life is better
and they are self-reliant.

Do you teach about
family planning? What else do you teach?

A: Yes, we teach about family
planning and how to use the available ways to space children to meet the needs
of a family. We also talk about reproductive physiology, so the women
understand both conception and how to prevent conception.

We teach nutrition and hydration
as those things, along with sanitation, form the foundation for good health.

We teach how the body works, in
general and the reproductive system specifically. We talk about those who might
be at higher risk in pregnancy.

We teach about conception and how
babies develop, and how the developing fetus and the parent affect each other. We then
teach about providing prenatal care, based on an understanding of what is
happening with both of them.

We teach about prenatal care, and labor and delivery
- what is happening and how to support it. We also teach about providing
postnatal care, too. This includes providing the best possible support for
natural feeding.

Through all this, we are teaching how to communicate persuasively with people and how to teach specific groups like children in secondary school or those attending the ante-natal clinic days.

At the end, but most important,
we teach about problem solving and change agency. We help the learners figure out
how to support themselves and make a difference in the community.

Then we return to provide
continuing education, to check on projects, and to answer questions. Each
month, Jitta visits each cohort for a couple of days to provide general support
and encouragement.

That's all!

Can you still see signs of the war?

A: Update: Fewer signs of war remain. The tanks on the roadside in places like Segbwema are gone. Blackened building still stand and mass graveyards exist in almost every village.

Original: Yes. The "Blood Diamond" or "Child Soldier" war ended in
about 2002; we arrived in 2006.

We
can still see physical signs - abandoned, rusty tanks on the side of the road
and burned out buildings throughout the country. The roads still have craters.
Because many bridges were blown up, the primary routes between towns have
changed to smaller, winding, indirect paths.

We
see amputees, and we drive by camps for them and for the former combatants who
cannot go back into society.

We
also see the women wearing layers of clothing - their husband's or son's
trousers under two or three skirts. They started this during the war, when
they'd have to escape night raids. They'd have extra skirts to wrap their
children in, or to use when hiding in the jungle for extended periods. The
trousers were helpful for forestalling rape.

We see sadness in the faces
of the people and listen to their stories.

What is the health care system in Sierra Leone like?

A: As Sierra Leone was run by the English, the health care system is loosely based
on that model. Most clinics are staffed and managed by the government. The
private hospitals and clinics tend to be much more expensive. The Ministry of
Health and Sanitation (MOHS) has a strategic plan which they created with an
eye on the World Bank, IMF, World Health Organization, and large
funders.

Sierra
Leone has about 6 million people, and about 60 MDs in practice. About 30 more are
administrators in MOHS and have no time for a practice. Most in practice work
in the three largest cities, serving a combined population of about 1.5
million. Each of the Districts (counties) has a hospital.

We
work mostly in the Kailahun, Bo, and Pujehun Districts, which have a total of a half-dozen or so doctors.

The
rural areas where we work have general clinics located in larger villages.
Maternity clinics are smaller and more numerous, to spare the people long walks
to a general clinic. Even so, some must walk 6-10 miles through the
jungle.

We teach in villages with a
maternity clinic, drawing our learners from surrounding villages. We integrate
the learners into the clinics, assisting the Maternal/Child Healthcare Aides
who typically staff them. Because their neighbors trust our learners, they will
come to the clinics for care.

How do you manage to
teach when the learners are illiterate and speak a different language?

A: We have a genius-level
interpreter. We could not do the work without her. She not only translates
words, she translates concepts. She not only translates concepts, she
translates culture.

For example, in the nutrition
module, we talk about fiber. The Mende language doesn't have a word for this;
it also lacks the concept. So Jitta will talk about slaughtering a goat. When
you clean the gut, you find the stringy, tough stems and branches. That is
fiber. That is the kind of translation that makes our teaching effective.

She grew up in Mende villages
during the war. She has butchered goats. She is also a nurse, and understands
the medical perspective and how clinics work.

She has earned the respect of thosef we teach, and she builds rapport. She models the attitudes we teach:
patience, kindness, humility. The students may be too timid at times to ask us
questions, but they trust her and they talk freely with her.

She has trained two other women to translate the program, to expand the capacity and sustainability of the program and the people.

And, yes, they are illiterate.
And they are very smart. And they live in a culture with a strong tradition of
story-telling, skits, and songs. So, we teach using a lot of pictures,
analogies, role plays, demonstrations, exaggeration, and so on. We tell of our
own experiences with the teaching points.

At the end of each module, we ask
them to create songs and skits summarizing what they learned. This has three
functions: We confirm that they learned the material correctly; they have a
tool to help them remember and review the material; and they have a way to
teach the other people in the village.

We have a final exam, which is
given individually, orally, through an interpreter. One interpreter, a public
health nurse from a clinic down the road, was astonished at the test. He was
shocked at how hard it was - he said several times that he couldn't have passed
it - and he was amazed at how well the women did. They knew things he didn't
know!

We are
proud of the instructional soundness of the course, and of how well our teams
have done, and of Jitta's translation skills, and most of all, we're proud of
those women who work hard so they can make change happen.

A: Trainers must be skillful teachers. This means they must build rapport and
trust quickly. They must think on their feet about metaphors and analogies that
work for this learner population. They must work effectively with our
translators. They must be able to present the information simply, concisely, and
effectively.

And
they must be able to cope with the living and working conditions - Mende food,
latrines (or not), sharing a bed, travel on horrifying roads, mosquito bites,
and taking malaria prophylaxis.

They
must support MOMS model in practical ways. MOMS does development not crisis
intervention. Partnership is key. So we always have to consider what we say and
do: Does this build independence or not? What kind of expectations might this
set? What unwanted messages might this send?

They
must abide by MOMS rules. These are fairly simple: Be polite. Don't imply you
can help someone get to America; be careful with stories of the wonders to be
seen in America. Be open. Enjoy the differences you find. Focus on teaching,
not working in the clinic. Focus on the learners, not on what you gain. If one
of the staff tells you to do something urgently, do it; ask questions later. Avoid contradicting or criticizing Gov’t policies and methods. Set an example
of what we teach about professionalism, humility, effectiveness, partnership. All this can be summed up as be respectful.

They
must have skills and knowledge in the subject matter they teach. We teach basic
women's reproductive health, community health, and change agency. Folks with
advanced skills and knowledge sometimes get frustrated because they have so
much more they want to teach. But the trips are not for trainers to teach what
they know; they are for the learners to get what they need.

They
must pay their own travel expenses to and from Freetown.

They
must read A Book for Midwives and Helping Health Workers learn. They must read
through our website, submit an application and waiver, and have an interview.

That's about it!

Where do you get funding?

A: From our friends, families,
and the folks they know. We do not get money from Save the Children, Bill
Gates, Oprah Winfrey, etc. We've asked these groups and many others, and have
applied for many grants. The typical response, phrased nicely, is that we're too
small, don't have enough US staff to do the necessary reporting, or have a
model that is too simple. We keep trying, though.

Fortunately, our simple model
means we have an annual budget of $50,000 - a rounding error for many of the
large funders, and the daily budget for some of the large agencies. So, when
someone gives us $1,000 - 2,000, it makes a huge difference. And more routine
gifts of $50 -100 add up quickly to a successful trip.

If someone gave us a million
dollars, like happened to Greg Mortenson, or even $100,000, we could focus
exclusively on training trainers and building independence — we’d get so much work done! It would be
lovely.

But, following in the steps of St
Francis of Assisi and some of the best Buddhists we know, we beg!

And to do something concrete, you
can click the Donate button below, or on any page of the
website!

Are you safe?

A: Pretty
much. The war in Sierra Leone had been over for about 4 years when we went the
first time. The people of the region have heard of us and are glad we're there,
and are very protective. Yep, there are some crazies out there, but there are
crazies everywhere. I've lived and worked in San Francisco, and have had knives
drawn on me, etc. Just like everywhere, we pay attention to whose around us. In
the cities, we watch for pickpockets and purse-snatchers, but we do that in
Dublin, London, New York, and SF, too! Traffic accidents and malaria are the
biggest threats to our well-being.

Addendum: We were in country when the Ebola epidemic started less than 50 miles away, but didn’t know it. We have been back since. We are careful to follow the guidelines to control transmission of disease that the Government of Sierra Leone mandated. We always follow Standard Precautions in clinical work.

So, how did you end up in
such a remote part of Sierra Leone?

Short A: Because Paramount Chief
Kallon pulled up in a Land Rover, and send "Get in; we're going to
Pellie."

Long A: We learned later that the
head woman of the village, Mamie Lamin, had a dream that white women with light
eyes would come and help the pregnant women. She reported this dream to the village
leaders and the Paramount Chief. He started looking for help, because of his
respect for Mamie and because he grieved for the sadness and loss in his home
village. He contacted an agency who contacted MOMS. When we arrived in country,
another Paramount Chief wanted us to go to his territory, but PC Kallon
"rescued" us in his truck, and off we went.

How did you get involved
in Sierra Leone to begin with?

A: Someone asked if we'd go to
Sierra Leone for two weeks and teach a group of women to become midwives. We
said, "No. But we will come and do a needs assessment, and figure out what
needs to be done and whether we can do it." So, we went, assessed needs,
decided what we could do, and wrote a proposal. We went back to pilot the
program, revised it, and continue to work. We have begun training trainers in order to increase independence.